椎管内分娩镇痛护理循证实践方案的构建

Development of evidence-based practice protocol for intrathecal labor analgesia

目的构建基于循证的椎管内分娩镇痛护理实践方案。方法以Stetler证据应用模式为理论框架,通过典型机构的现场观察,梳理焦点问题,系统检索文献,提取证据及推荐意见,构建方案草案,进行专家论证,确定推荐等级,形成最终方案。结果方案包括分娩疼痛的评估及初步处理、椎管内分娩镇痛开始时机、镇痛前准备、镇痛期间的监护与管理、镇痛产妇的活动管理、饮食管理、镇痛结束时机7个方面共41条推荐意见,其中38条强推荐,3条弱推荐。结论构建椎管内分娩镇痛护理循证实践方案,有利于多学科助产团队在临床实践过程中达成一致,为下一步临床实施奠定基础。

Objective To develop an evidence-based practice protocol for intrathecal labor analgesia.Methods Using the Stetler Model of research utilization as theoretical framework,we developed draft protocol based on field observation,identification of focus problems,literature reviewing,and extraction of evidence and recommendations.Then expert consultation was conducted to identify recommendation grade and to formulate the final protocol.Results The protocol included seven dimensions and 41 recommendations(38 strong recommendations and 3 weak recommendations) :assessment and preliminary management of labor pain,commencement of intrathecal labor analgesia,preparation before intrathecal labor analgesia,monitoring and management during intrathecal labor analgesia,activity management,dietary management,and termination of intrathecal labor analgesia.Conclusion The development of evidence-based practice protocol for intrathecal labor analgesia facilitates the achievement of multidisciplinary team agreement,thus to provide foundation for clinical practice.